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ORIGINAL RESEARCH article

Front. Phys.

Sec. Social Physics

Volume 13 - 2025 | doi: 10.3389/fphy.2025.1659506

Modeling the evolution of inter-hospital referral networks: An agent-based modeling approach

Provisionally accepted
Tao  YangTao Yang1Jie  FanJie Fan2Wenbin  GuWenbin Gu1Jing  QinJing Qin1Bing  DengBing Deng3Wenwen  DengWenwen Deng3*Wei  WangWei Wang1*
  • 1Chongqing Medical University College of Public Health, Chongqing, China
  • 2Chongqing Medical and Pharmaceutical College, Chongqing, China
  • 3Chongqing Public Health Medical Center, Chongqing, China

The final, formatted version of the article will be published soon.

In many countries, especially large developing nations like China, hierarchical healthcare systems face persistent structural challenges such as unbalanced resource allocation and inefficient referral networks. To capture the impact of individual behavior on the evolution of healthcare system structures, this study develops an agent-based modeling (ABM) approach to simulate the dynamic formation of inter-hospital referral networks. The model introduces a strategic game-theoretic mechanism among patients, where each agent makes referral decisions based on multiple factors, including medical benefits, commuting costs, and limited information, under resource constraints. Through these decentralized decisions, a directed and weighted referral network emerges, reflecting realistic behavioral patterns. Based on the simulated network, topological analysis is performed to identify key hospitals and design targeted resource allocation strategies. The results show that tertiary hospitals exhibit high centrality, indicating a structural 'Matthew effect'. In addition, compared to simply strengthening core hospitals, the referral bottleneck mitigation strategy can reduce patient loss, while also decreasing the overall referral frequency within the system. Based on these findings, the study proposes a multilevel reform framework spanning operational, institutional, and strategic dimensions to support the restructuring of hierarchical healthcare systems through game-theoretic and optimization approaches.

Keywords: Healthcare system, Referral, Agent-based modeling, Inter-hospital referral networks, Network analysis

Received: 04 Jul 2025; Accepted: 04 Aug 2025.

Copyright: © 2025 Yang, Fan, Gu, Qin, Deng, Deng and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Wenwen Deng, Chongqing Public Health Medical Center, Chongqing, China
Wei Wang, Chongqing Medical University College of Public Health, Chongqing, China

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